Provider Demographics
NPI:1780907782
Name:MICHAEL N KLEAMENAKIS
Entity type:Organization
Organization Name:MICHAEL N KLEAMENAKIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEAMENAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-288-2333
Mailing Address - Street 1:4114 MARIGNY ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4931
Mailing Address - Country:US
Mailing Address - Phone:504-288-2333
Mailing Address - Fax:504-288-2227
Practice Address - Street 1:4114 MARIGNY ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70122-4931
Practice Address - Country:US
Practice Address - Phone:504-288-2333
Practice Address - Fax:504-288-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-04
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1030-060T261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1370142Medicaid
LA48365Medicare UPIN